Provider Demographics
NPI:1437475308
Name:PENTO HOMECARE AGENCY, INC
Entity Type:Organization
Organization Name:PENTO HOMECARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PENTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-322-1683
Mailing Address - Street 1:54A LEBANON AVE.
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4127
Mailing Address - Country:US
Mailing Address - Phone:724-322-1683
Mailing Address - Fax:724-437-2629
Practice Address - Street 1:54A LEBANON AVE.
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4127
Practice Address - Country:US
Practice Address - Phone:724-322-1683
Practice Address - Fax:724-437-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102981387-0001Medicaid
PA102981387Medicaid